Many Americans grapple with anxiety on a regular basis. In fact, anxiety disorders are the most common types of mental health disorders in the U.S. with over 40 million people struggling. Anxiety can be debilitating, touching off highly uncomfortable physical symptoms such as a racing heart, palpitations, stomach distress, and insomnia. Unfortunately, many who battle chronic anxiety may never get the professional help needed, and instead come to rely on a relaxation-inducing substance like alcohol to help mitigate their symptoms.

While alcohol may offer some relief from the anxiety symptoms initially, over time, as with any substance that alters brain structures and chemistry, tolerance increases and so does alcohol consumption. This can culminate in an unhealthy cycle of anxiety and alcoholism, or a dual diagnosis. A dual diagnosis is present when a mental health disorder co-occurs with a substance use disorder.

It isn’t hard to understand how anxiety and alcoholism are linked. Alcohol is a depressant, meaning that it has a direct impact on the central nervous system, not only reducing the feelings of stress but also providing a sense of euphoria. For someone trying to manage daily stressors, reaching for a drink or two to quell the anxiety seems logical. In reality, however, alcohol use for self-medicating a mental health condition rarely remains static. As the level of consumption increases, the impact on the brain’s reward system and pathways will set in motion a deleterious cycle of anxiety and alcoholism, each disorder exacerbating the other.

The solution is twofold: to detox from alcohol and enter a treatment program that results in sobriety, and learning how to better regulate stress and manage the anxiety disorder. This requires the individual to commit to addressing both the alcohol use disorder and the anxiety disorder at the same time for the best recovery outcome.

About Anxiety Disorder

Anxiety can take various forms, each centering on the feelings of excessive worry, fear, or dread. The primary types of anxiety disorder include:

Generalized anxiety disorder. GAD involves excessive worry that is irrational. While normal to worry about such things as finances, relationships, work, and family, it becomes a disorder when persistent worry becomes all-consuming and negatively impacts daily life.

Social anxiety. Social anxiety disorder centers features an intense fear of being judged or ridiculed. An individual suffering from social anxiety will avoid situations that would focus attention on them. Social and work events, as well as performance activities and public speaking, are avoided.

Panic disorder. Panic disorder is also referred to as having panic attacks, the spontaneous and unpredictable events that are characterized by a racing heart, heart palpitations, chills, nausea, chest pains, trembling, and shortness of breath. These attacks last only minutes before subsiding, although at the time they are frightening, resembling a heart attack.

Post-traumatic stress disorder. PTSD is closely associated with the anxiety spectrum and results from an intense traumatic experience, such as witnessing or experiencing a physical or sexual assault, a natural disaster, or the combat-related violence. Individuals with PTSD struggle with recurring and disturbing memories of the event or vivid nightmares. They may avoid people or places that trigger memories of the event, exhibit detachment behaviors, and may be easily startled or frightened.

Phobia. Specific phobias entail having intense and irrational specific fears, such as a fear of heights or fear of spiders. Phobias can lead to isolation and avoidance behaviors, which can reduce quality of life. Claustrophobia, for example, is the fear of being in crowded spaces and might impact many aspects of life, such as public transportation, riding on elevators, or visiting amusement parks.

Obsessive-compulsive disorder. OCD involves obsessions, the recurrent invasive thoughts, actions, and mental images that torment the individual, and compulsions, the repetitive, systematic behaviors employed to relieve anxiety or distress. Examples of OCD are being obsessed with germs, the fear of losing things, or ordering things in a particular way. The resulting compulsions might involve washing hands dozens of times per day or turning off the light switch twenty times before leaving a room.

About Alcohol Use Disorder (AUD)

The signs and symptoms of alcoholism include behavioral, physical, and psychological elements. Alcohol use disorder (AUD) is diagnosed by a list of criteria determined by the DSM-5, which then sorts these by the number of symptoms present into three different levels of severity. Mild AUD involves 2-3 criteria, moderate AUD features 4-5 criteria, and severe AUD 6 or more criteria.

The diagnostic criteria include:

Higher consumption of alcohol or over a longer period of time than is intended

Making unsuccessful attempts to cut down or control alcohol use

Significant time spent obtaining, using, and recovering from the effects of alcohol.

Recurrent alcohol use impairs ability to fulfill obligations at work, school, or home

Recurrent use of alcohol, despite having persistent or recurring social or interpersonal problems caused by or worsened by alcohol

Alcohol cravings

Skipping important social, occupational, or recreational activities due to alcohol use

Recurrent alcohol use in high risk situations, such as driving

Experience withdrawal symptoms when alcohol is withheld

The relaxing properties of ethyl alcohol make it particularly attractive to individuals hoping to self-medicate the unpleasant effects of an anxiety disorder. According to an article published by the National Institute of Alcohol Abuse and Alcoholism, researchers found that both men and women who reported higher levels of stress tended to drink more, with men having a 2.5 times higher rate of an AUD.

The Centers for Disease Control have issued guidelines that help individuals understand safe levels of alcohol consumption. The CDC considers moderate alcohol intake as no more than one alcoholic beverage daily for women, or two per day for men.

Treatment for a Dual Diagnosis

Getting help for anxiety and alcoholism requires the expertise of a dual diagnosis rehab program. These specialized programs provide both the addiction recovery expertise and the psychiatric support to manage and treat both disorders simultaneously. After a careful evaluation and diagnosis is made, the typical course of treatment will include:

Alcohol withdrawal management. A medically monitored detox and withdrawal will allow the individual to expel the residual effects of the alcohol from the body so they can stabilize prior to beginning therapy.

Individual psychotherapy. Psychotherapy will address both the anxiety disorder and the addiction behaviors. Cognitive behavioral therapy helps the patient identify distorted perceptions or irrational thoughts they may display in response to the situations or triggers that can stoke anxiety or lead to alcohol misuse. CBT treatment can help the individual change their dysfunctional thought patterns by having them practice using different responses to the triggering events. This will result in new healthy behavioral responses, which can help mitigate the anxiety as well as sustain sobriety. Also, exposure-focused psychotherapy can help individuals with anxiety by incrementally reducing the impact of the stress-provoking trigger or memory.

Group work. A fundamental piece of addiction and mental health recovery is the use of small groups to open up discussions that can be beneficial for participants. In group therapy or family therapy a therapist will guide discussions by introducing topics pertaining to recovery. These discussions allow the freedom for individuals to share their personal experiences and fears in a safe, nonjudgmental space.

Medication. Medication may be provided for helping the individual manage both the anxiety and alcoholism. Anti-anxiety drugs, called benzodiazepines, can assist with reducing stress levels, and naltrexone may be used to help reduce alcohol cravings in early recovery.

Relapse prevention planning. Making a plan for recovery involves creating a proactive relapse prevention strategy. Individuals identify their personal triggers and then note the actions to take to avoid relapse when these triggers emerge.

Activities. Recreational activities and holistic therapies can round out a dual diagnosis program, offering a respite to the hard work of daily therapy, as well as a means of reducing stress. Activities may involve outdoor sports, hikes, yoga, or art therapy.

Diet and Exercise Help Manage Anxiety

In recovery it is important to incorporate healthy lifestyle habits, such as getting regular exercise and embracing a nutritious diet. There is a direct connection between our physical health and our mental wellbeing, so diet and exercise are key in maintaining emotional stability in recovery.

When we are physically active, the body produces more dopamine and serotonin, brain chemicals, or neurotransmitters, that help boost mood, reduce stress, and improve sleep quality. Engaging in at least three 30-60 minute workouts weekly is optimal.

To restore health in recovery it is important to limit processed foods, sugary treats and sodas, and high fat foods. Include foods that provide essential fatty acids, such as fish, nuts, and seeds, as well as fresh vegetables and fruits, whole grains, low-fat dairy, and lean protein sources.

Relaxation Techniques and Coping Skills

Stress is a significant risk factor for alcohol relapse. To reduce that risk it is essential that individuals in recovery take advantage of activities that can quickly help reduce feelings of anxiety or stress. Holistic therapies can help individuals in recovery manage anxiety throughout the day. There are a wide variety of relaxation-inducing activities that can be easily accessed. These might include:

Yoga classes

Deep breathing techniques

Massage therapy

Aromatherapy

Acupuncture

Equine therapy

Gardening

Journaling

Meditation

In addition to engaging in these stress-reducing activities, it is also important to practice the new coping skills learned in rehab. Begin to use the new thought patterns learned in CBT to make fundamental changes in daily decision-making and actions. Utilize the new communication skills taught in group therapy sessions for better interpersonal connections. Recovery skills are not learned overnight, they must be practiced until they become second nature.

Establish a Support System in Recovery

An aspect of dual diagnosis recovery that often gets little attention is aftercare efforts. It is one thing to successfully complete the rehab program, and quite another to sustain recovery long-term. Without support, it is very difficult to succeed. In early recovery, it is critical to have a defined support system established. This support becomes the backstop, the sounding board that can assist recovery just by being available during vulnerable moments.

There are several excellent support sources to consider. These might include:

Sober living housing. A sober living environment provides a safe, substance-free living space shared with others in recovery. In many ways, the housemates become an important source of support and accountability during the early months of recovery.

Recovery community. Joining a local A.A. group or a similar type of recovery community can provide several social support resources. Members can offer each other encouragement at or after the meetings, and sponsors are available to offer additional support if desired.

Outpatient therapy. Weekly meetings with a therapist can have tremendous benefits in recovery, especially during the first year. People are often surprised at the challenges or issues that can emerge in the early months of recovery that can threaten sobriety. Having a therapist available to help navigate these situations successfully can help avert a relapse.

A confidante. Have someone in your corner, a trusted friend, colleague, or family member, who is willing to occasionally serve as a sober companion at a social event or who will just sit and listen when feelings of loneliness or fear emerge. A confidante is an ally in recovery, a person who cares about your recovery success.

Next Level Recovery serves the Salt Lake City metropolitan area, providing the full spectrum of addiction recovery services. These services include outpatient treatment, intensive outpatient programming, partial hospitalization programming, residential treatment, and sober living housing. The clinical team at Next Level is committed to partnering with you or a loved one to help achieve a successful recovery. Using a “whole-life” approach to addiction recovery, Next Level aims to help clients improve functioning in all aspects of their life, including health and emotional wellbeing as well as interpersonal and career. For more information about anxiety and alcoholism, please reach out to the team at Next Level Recovery today at (888) 759-5846.